Easter Bash Registration Form

3rd -6th April 2017

Details of Child:
Name [required]:
Date of Birth [Required]:
School:
School Year [2016/2017]:
Gender: MaleFemale
Parent/Guardian Details:
Name [Required]:
Telephone Number:
Address:
Mobile Number:
Email:
Second Contact:
Name [Required]:
Contact Number:
If you will not be collecting your child at the end of the session, please give the name and contact details of the person who will be collecting them:
Contact Name:
Contact Number:
If you want your child to walk home: [Please tick the box] YesNo
Medical Details:
Registered GP's Name & Address [Required]:
Telephone Number [Required]:
Does your child have any allergies, or medical or special needs we should be aware of? [Required] YesNo
Please provide further details:
Declaration:
I give permission for my child's and my details to be stored by the church: AgreeDisagree
I give permission for my child's photograph to be taken during the kids club: [Photographs may be used for church purposes, including publicity in social media and local press] AgreeDisagree
I give permission for my child's to attend the kids club, acknowledging that some games may be played on the sports field of Thomas Gainsborough School: AgreeDisagree
I give permission for my child's to apply sun cream if the weather requires: AgreeDisagree
In the event of illness/accident, I give permission to give any appropriate first aid/medical treatment to be given by a doctor or first aider: AgreeDisagree
Signature of Parent/Guardian: [By ticking the box you are signing the document] Agree